Japan Agency Research Articles

Two new species of the sponge associated axiid shrimp genus Eiconaxius Bate, 1888 (Decapoda: Axiidea) from seamounts in the Nishi-Shichito Ridge, Japan

Two new species of the axiid shrimp genus Eiconaxius Bate, 1888, are described from seamounts in the Nishi-Shichito Ridge, northwestern Pacific off Japan, during recent cruises of R/V Kaimei of the Japan Agency for Marine-Earth Science and Technology, exploring the marine protected area (MPA). Eiconaxius latirostrum sp. nov. is described on the basis of three specimens from Shoho Seamount at depths of 402–456 m; and E. kaimei sp. nov. is described on the basis of a single ovigerous female from An’ei Seamount at a depth of 888 m. The status of the two new taxa was assessed by phylogenetic analyses employing two mitochondrial markers (16S rRNA and COI genes) and morphological comparison. Specimens of the two new species lived in colonies of unidentified farreid sponges. This study contributes to documenting the benthic invertebrate fauna of the Japanese MPA as a baseline data for conservation.

Особенности развития полиции Японии: история и современность

This article highlights the issue of the history of the development of the Japanese police and its current state. The interest in this topic is due to the traditionally high level of security in modern Japan, which is ensured, among other things, due to the effective activities of its law enforcement system. The positive experience of the Japanese police in combating crime and ensuring law and order has already been borrowed by a number of Asian countries, but little studied in our country. The main focus of the article is on the consistent disclosure of the development process of law enforcement agencies in Japan. Three stages of their formation are highlighted. The current stage of development of law enforcement agencies in Japan is considered in more detail. The author presents the structure and size of the police, the peculiarities of the distribution of employees in the center and in the field, presents the functions of the police and the priority areas of its activities. The author highlights the issue of police interaction with citizens as the most important factor in ensuring security. In this aspect, the author believes that the experience of the Japanese police reform in the early 2000s deserves close attention, which ensured an increase in citizens' trust in the police, the development of new forms of interaction with the population, contributed to improving the quality of police activities and directly affected the results of law enforcement officers, first of all a decrease in crime and an increase in crime detection.

True Benefits of Immune Checkpoint Inhibitors in the Treatment of Malignant Pleural Mesothelioma in Japan.

In February 2004, the Food and Drug Administration (FDA) was the first to approve the combination of cisplatin (CDDP) and pemetrexed (PEM) as standard first-line chemotherapy for untreated, unresectable malignant pleural mesothelioma (MPM). However, after that approval, no progress was made in the standard first-line treatment of MPM for almost 15 years. Positive results from a phase 3 study (Mesothelioma Avastin Cisplatin Pemetrexed Study: MAPS) verifying the effect of bevacizumab, an anti-angiogenesis agent added to CDDP/PEM for unresectable MPM, were published in The Lancet in December 2015; however, this did not lead to approval by national drug regulatory agencies. Furthermore, no second-line treatment was established for cases refractory to CDDP/PEM. In August 2018, the Pharmaceuticals and Medical Devices Agency of Japan was the first in the world to approve monotherapy with nivolumab, an immune checkpoint inhibitor (ICI), for previously unresectable, advanced, or recurrent MPM. Following Japan, in October 2020, the FDA approved the combination of nivolumab and ipilimumab for the treatment of previously untreated, unresectable MPM. In this article, we review the transition of drug treatment for MPM, in light of the historical background, focusing on the benefits of ICIs.

ЖАПОНИЯДАҒЫ САЛЫҚТЫҚ ӘКІМШІЛЕНДІРУДІ ЦИФРЛАНДЫРУ ТӘЖІРИБЕСІН ЗЕРТТЕУ

The tax policy of the state in conjunction with the methods of tax administration is a determining factor influencing the amount of tax revenues of the budget. Tax discipline, forms and close interaction between taxpayers and regulatory authorities also play a significant role. The development of information and communication technologies (ICT) in recent decades has provided the tax authorities with a wide range of opportunities to increase government revenue, improve the efficiency and quality of services provided to taxpayers, including electronic filing of returns and payment of taxes, while reducing the administrative burden on taxpayers and reducing public administration costs. The first phase of digitalization was the computerization of routine tax administration processes (such as taxpayer registration and income records), and in the second half of last decade and early this decade, many tax authorities adapted their websites to simplify operations by introducing online forms and calculators for taxpayers. In June 2017, Japan National Tax Agency published a strategic plan for the Japanese tax administration called "Looking to the Future." This includes the pursuit of sound taxation and good governance to ensure that taxes are paid based on the understanding and trust of taxpayers. The National Tax Agency of Japan is well aware of the importance of continually moving toward the future it seeks, emphasizing the goal of transparent tax administration. Keywords: tax and customs administration, OECD countries, tax and customs, administrative costs, Tax Code, tax authorities, taxpayers, tax relations, digitalization.

Efficacy of a new vacuum erection device (Vigor 2020) for erectile dysfunction: A retrospective study in Japan.

The vacuum erection device (VED) is a second-line treatment tool recommended in erectile dysfunction (ED) guidelines but has long been unavailable in Japan. A new VED, Vigor 2020® (A & HB Company Limited, Tokyo, Japan), has now been manufactured and received medical approval from the Pharmaceuticals and Medical Devices Agency in Japan. We conducted a retrospective observational study of ED patients who used Vigor 2020 in clinical practice. We analyzed male ED patients aged ≥20 years treated with Vigor 2020 in our outpatient clinics. The primary endpoint was improvement of erection as evaluated by an Erection Hardness Score (EHS) of ≥1 point. Secondary endpoints were improvement of sexual function and adverse events as evaluated by the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ-EjD). Thirty-three patients (mean age, 57.21 [27-86] years) could be evaluated before and after using Vigor 2020. Among the 16 patients with baseline EHS ≤2, 14 (93.33%) improved by ≥1 point, and 10 of these 16 patients (62.50%) improved to EHS ≥3 and could insert vaginally. Significant improvement was observed for IIEF total score and for the MSHQ-EjD in patients with an EHS of ≥3 after use of Vigor 2020. No patient experienced significant adverse events. The Vigor 2020 may be an efficacious treatment tool for ED. Patients with significant ED experienced not only significant improvement of erection but also improvement of ejaculation with its use.

Upfront or delayed surgery in resectable hepatoblastoma: analysis from the children’s hepatic tumors international collaboration database

In the treatment of resectable hepatoblastoma (HB), it has not been established whether upfront surgery (UF) at diagnosis or neoadjuvant chemotherapy and delayed surgery (DL) is preferred. We compared patients with localized HB who underwent either UF, or DL after neoadjuvant chemotherapy in the Children's Hepatic tumors International Collaboration (CHIC) database of 1605 cases enrolled in eight multicenter hepatoblastoma trials between 1988 and2010. Among the 512 resectable HB patients who had PRETEXT (PRETreament EXTent of disease) I or II unruptured tumors at diagnosis without extrahepatic invasion, distant metastases, or massive vascular invasion, 172 underwent UF and 340 underwent DL. The primary outcomes were event-free and overall survivals after start of treatment in these two groups. Survival analysis was performed using the Kaplan-Maier analysis with long-rank tests and multivariable Cox regression models. Complete resection rates were comparable (93.6% in UF and 89.7% in DL). The total cycles of chemotherapy of DL (median:6) were significantly more than those of UF (median:4) (P<0.01). The 5-year event-free survival (EFS) was 90.6% and 86.6% (P=0.89) in the UF and DL cohorts, respectively. The surgical complications, recurrence rates, and late complications were not significantly different between the cohorts but the EFS rates of DL patients with a low alpha-fetoprotein (AFP) level (100-999ng/mL) or older age at diagnosis (≥3 years old) were significantly worse than others. The outcomes, surgical resectability, and complications were not significantly different between the UF and DL groups. Eligible patients with a low AFP level (<1000ng/mL) or older age (≥3 years old) showed better outcomes in the UF group and might be considered for initial resection. European Network for Cancer Research in Children and Adolescents, funded through the Framework Program 7 of the European Commission; Children's Oncology Group Cure Search grant contributed by the Hepatoblastoma Foundation; Practical Research for Innovative Cancer Control and Project Promoting Clinical Trials for Development of New Drugs and Medical Devices, Japan Agency for Medical Research and Development; Japan Society for the Promotion of Science; and Swiss Cancer Research grant.

Postoperative Management of Aneurysmal Subarachnoid Hemorrhage

Delayed cerebral ischemia(DCI) is one of the most significant complications of subarachnoid hemorrhage. Despite significant evolution in understanding DCI pathophysiology, vasospasm affecting cerebral vessels of large and moderate diameters remain the only clinically measurable component of DCI and is therefore the primary target for intervention in the postoperative management of subarachnoid hemorrhage. In Japan, fasudil hydrochloride and ozagrel sodium are widely used to prevent vasospasms; however, their effects are sometimes insufficient. Clazosentan, a selective endothelin receptor subtype A antagonist, reduces vasospasm-related morbidity and all-cause mortality following aneurysmal subarachnoid hemorrhage. This was demonstrated in a recent randomized phase 3 trial, leading to the approval of clazosentan by the Pharmaceuticals and Medical Devices Agency in Japan. Recent advances in our understanding of subarachnoid hemorrhage will facilitate improved management to reduce the incidence of DCI.

Cavity ionization chamber responses in the JAEA and the NMIJ high-energy photon reference fields for radiation protection

The dosimeter response should be calibrated in a reference field near the user's radiation environment. Environments around nuclear reactors and radition therapy facilities have high-energy photons with energies exceeding that of60Co gamma rays, and controlling exposure to these photons is important. The Japan Atomic Energy Agency (JAEA) and National Metrology Institute of Japan (NMIJ) have high-energy reference fields with energies above several MeV for different types of accelerators. Their reference fields have different fluence-energy distributions. In this study, the energy dependencies of the two-cavity ionization chambers, which are often used by secondary laboratories, were experimentally and computationally evaluated for each high-energy field. These results agreed well with relative expanded uncertainties (k= 2), and their capabilities for air kerma measurements in each high-energy reference field were confirmed. Therefore, the capabilities of the air-kerma measurements can be verified in the two high-energy reference fields.&#xD.

Curriculum Development and Teachers for Cultivating OECD Student Agency in Japan: From an Examination of Educational Thought, Educational System, History, and Contemporary Science and Mathematics Education Practices

Curriculum Development and Teachers for Cultivating OECD Student Agency in Japan: From an Examination of Educational Thought, Educational System, History, and Contemporary Science and Mathematics Education Practices

Integrated Collection and Publication of Sample Metadata in JAMSTEC: A System Maximizing Sample Values and Assisting in Sample Management

The Japan Agency for Marine-Earth Science and Technology (JAMSTEC) has collected a lot of samples (e.g., organisms, rocks, sediment cores) from the deep sea, seafloors and other extreme environments. These samples are difficult to collect again by JAMSTEC and other institutions because of their remoteness, so we thought it important to make them available to as many people as possible for a variety of purposes. JAMSTEC established the “Basic Policies on the Handling of Data and Samples” in 2007, and its data management office (DMO) has operated a centralized management and publication of metadata for almost all samples collected during research cruises (Tsuboi et al. 2014). While researchers who collected samples retain priority rights of use, publishing the metadata opens the door for third parties to apply for sample usage. To properly manage and publish those metadata of the samples, DMO has constructed and operates databases, including the JAMSTEC Sample Database for sample management and the DARWIN database for the publication of cruise data and sample metadata. Some biological sample metadata is also shared with JAMSTEC’s biogeographic database (BISMaL), and global databases such as Ocean Biodiversity Information System (OBIS) and the Global Biodiversity Information Facility (GBIF) (Iseto et al. 2019; Fig. 1). Traditionally, researchers have deposited selected samples in museums or resource centers and made that information public through literature or via online databases. However, the samples accessible through these routes represent only a small portion of the total samples collected by researchers. What JAMSTEC does is different from this, in that JAMSTEC publishes metadata of most collected samples (Fig. 2). JAMSTEC manages sample metadata not only to respond to sample requests from third parties, but also for its own benefits. The sample management assists JAMSTEC’s research in collaborative opportunities, sample inheritances, and research compliance. Most notably, among recent global regulations, proper sample management has become essential to complying with diverse treaties and laws such as Security Export Control and Nagoya Protocol on Access and Benefit Sharing. Now that we have established this system, we are moving to the next stage, where each JAMSTEC researcher can register and update their own sample metadata, and control public settings of the sample metadata themselves on the database without relying heavily on DMO. We hope that the JAMSTEC initiative will become a revitalizing model for sample-based research.

Comparison of platinum combination chemotherapy plus pembrolizumab versus platinum combination chemotherapy plus nivolumab–ipilimumab for treatment-naive advanced non-small-cell lung cancer in Japan (JCOG2007): an open-label, multicentre, randomised, phase 3 trial

The combination of platinum-based chemotherapy and an antibody to PD-1 or to its ligand PD-L1, with or without an antibody to CTLA-4, has improved the survival of individuals with metastatic non-small-cell lung cancer (NSCLC). However, no randomised controlled trial has evaluated the survival benefit of adding a CTLA-4 inhibitor to platinum-based chemotherapy plus a PD-1 or PD-L1 inhibitor. This open-label, randomised, phase 3 trial was conducted at 48 hospitals in Japan. Eligible patients were aged 20 years or older with previously untreated advanced NSCLC and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients with known driver oncogenes were excluded. Participants were randomly assigned (1:1) to receive platinum-based chemotherapy (four cycles) plus pembrolizumab (pembrolizumab group) or platinum-based chemotherapy (two cycles) plus nivolumab-ipilimumab (nivolumab-ipilimumab group). The primary endpoint was overall survival and assessed in all randomly assigned patients on an intention-to-treat basis. The trial is registered in the Japan Registry for Clinical Trials, jRCTs031210013, and is now closed to new enrolment and is ongoing. Between patient accrual initiation on April 6, 2021, and discontinuation of the trial on March 30, 2023, 11 (7%) of 148 patients in the nivolumab-ipilimumab group had a treatment-related death. Because of the high number of treatment-related deaths, patient accrual was terminated early, resulting in 295 patients (236 [80%] male and 59 [20%] female) enrolled; the primary analysis was done on the basis of 117 deaths (fewer than the required 329 deaths). By May 25, 2023 (data cutoff), overall survival did not differ significantly between the nivolumab-ipilimumab group and the pembrolizumab group (median 23·7 months [95% CI 17·6-not estimable] vs 20·5 months [17·6-not estimable], respectively; hazard ratio 0·98 [90% CI 0·72-1·34]; p=0·46). Non-haematological adverse events of grade 3 or worse occurred in 87 (60%) of 146 patients in the nivolumab-ipilimumab group and 59 (41%) of 144 patients in the pembrolizumab group. The pembrolizumab group tended to have a better quality of life compared with the nivolumab-ipilimumab group. The safety and efficacy data suggest an unfavourable benefit-risk profile for nivolumab-ipilimumab combined with platinum-based chemotherapy relative to pembrolizumab combined with platinum-based chemotherapy as a first-line treatment for patients with advanced NSCLC, although a definitive conclusion awaits an updated analysis of overall survival. The National Cancer Center Research and Development Fund and Japan Agency for Medical Research and Development.

Cardiovascular Pharmacogenetics: From Discovery of Genetic Association to Clinical Adoption of Derived Test.

Recent breakthroughs in human genetics and in information technologies have markedly expanded our understanding at the molecular level of the response to drugs, i.e., pharmacogenetics (PGx), across therapy areas. This review is restricted to PGx for cardiovascular (CV) drugs. First, we examined the PGx information in the labels approved by regulatory agencies in Europe, Japan, and North America and related recommendations from expert panels. Out of 221 marketed CV drugs, 36 had PGx information in their labels approved by one or more agencies. The level of annotations and recommendations varied markedly between agencies and expert panels. Clopidogrel is the only CV drug with consistent PGx recommendation (i.e., "actionable"). This situation prompted us to dissect the steps from discovery of a PGx association to clinical translation. We found 101 genome-wide association studies that investigated the response to CV drugs or drug classes. These studies reported significant associations for 48 PGx traits mapping to 306 genes. Six of these 306 genes are mentioned in the corresponding PGx labels or recommendations for CV drugs. Genomic analyses also highlighted the wide between-population differences in risk allele frequencies and the individual load of actionable PGx variants. Given the high attrition rate and the long road to clinical translation, additional work is warranted to identify and validate PGx variants for more CV drugs across diverse populations and to demonstrate the utility of PGx testing. To that end, pre-emptive PGx combining genomic profiling with electronic medical records opens unprecedented opportunities to improve healthcare, for CV diseases and beyond. SIGNIFICANCE STATEMENT: Despite spectacular breakthroughs in human molecular genetics and information technologies, consistent evidence supporting PGx testing in the cardiovascular area is limited to a few drugs. Additional work is warranted to discover and validate new PGx markers and demonstrate their utility. Pre-emptive PGx combining genomic profiling with electronic medical records opens unprecedented opportunities to improve healthcare, for CV diseases and beyond.

(Invited) Carbon Sulfonation Using Plasma: Trial to Enlarge Treatment Capacity

Heterogeneous catalysis is a promising technology in conversion of biomass to biofuels because of its high reactivity, easy post-separation, and great recyclability compared to homogeneous catalysis. Various functionalized catalytic materials have emerged as promising alternatives to the homogeneous liquid acid catalyst, such as carbon materials, metal–organic frameworks, and metal nanoparticles. Among them, carbon materials such as carbon nanotube, graphene oxide, carbon black, and so on have been investigated as catalysts for cellulose hydrolysis to produce glucose.Carbon materials show considerable catalytic activity by functionalization with active acidic groups including hydroxyl groups (-OH), carboxyl groups (-COOH), and sulfonic groups (-SO3H). Hydroxyl and carboxyl groups on the carbon catalysts act as connection center to access cellulose, where sulfonic group serves as the active site to cut off the linkage between glucose units in cellulose. So, the surface modification of carbon materials with these functional groups, namely, carbon sulfonation process, becomes the determining step to producing efficient carbon acid catalysts. Conventional methods for the carbon sulfonation are the hydrothermal and reflux method, in which hazardous chemicals are necessary, such as concentrated sulfuric acid (95–98%), chlorosulfonic acid, fuming sulfuric acid, or 4-benzenediazoniumsulfonate under elevated temperature for dozens of hours.As a green and effective carbon sulfonation process, we have utilized plasma generated in contact with dilute sulfuric acid. Recently, we have investigated the mechanism of carbon sulfonation in GLIP processes. Active species produced near the gas–liquid interface such as •OH, SO3, and HOSO2• probably play important roles in carbon sulfonation. We are currently trying to enlarge the treatment capacity of carbon sulfonation by two methods, namely parallel plasma generation with ballast capacitors and large-area plasma generation by a dielectric barrier discharge. Also, effects of gases used for plasma generation such as air and Ar on the carbon sulfonation are investigated.This work was partially supported by the Environment Research and Technology Development Fund (JPMEERF20223R01) of the Environmental Restoration and Conservation Agency of Japan.

γ-Secretase activity, clinical features, and biomarkers of autosomal dominant Alzheimer's disease: cross-sectional and longitudinal analysis of the Dominantly Inherited Alzheimer Network observational study (DIAN-OBS)

Genetic variants that cause autosomal dominant Alzheimer's disease are highly penetrant but vary substantially regarding age at symptom onset (AAO), rates of cognitive decline, and biomarker changes. Most pathogenic variants that cause autosomal dominant Alzheimer's disease are in presenilin 1 (PSEN1), which encodes the catalytic core of γ-secretase, an enzyme complex that is crucial in production of amyloid β. We aimed to investigate whether the heterogeneity in AAO and biomarker trajectories in carriers of PSEN1 pathogenic variants could be predicted on the basis of the effects of individual PSEN1 variants on γ-secretase activity and amyloid β production. For this cross-sectional and longitudinal analysis, we used data from participants enrolled in the Dominantly Inherited Alzheimer Network observational study (DIAN-OBS) via the DIAN-OBS data freeze version 15 (data collected between Feb 29, 2008, and June 30, 2020). The data freeze included data from 20 study sites in research institutions, universities, hospitals, and clinics across Europe, North and South America, Asia, and Oceania. We included individuals with PSEN1 pathogenic variants for whom relevant genetic, clinical, imaging, and CSF data were available. PSEN1 pathogenic variants were characterised via genetically modified PSEN1 and PSEN2 double-knockout human embryonic kidney 293T cells and immunoassays for Aβ37, Aβ38, Aβ40, Aβ42, and Aβ43. A summary measure of γ-secretase activity (γ-secretase composite [GSC]) was calculated for each variant and compared with clinical history-derived AAO using correlation analyses. We used linear mixed-effect models to assess associations between GSC scores and multimodal-biomarker and clinical data from DIAN-OBS. We used separate models to assess associations with Clinical Dementia Rating Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), and Wechsler Memory Scale-Revised (WMS-R) Logical Memory Delayed Recall, [11C]Pittsburgh compound B (PiB)-PET and brain glucose metabolism using [18F] fluorodeoxyglucose (FDG)-PET, CSF Aβ42-to-Aβ40 ratio (Aβ42/40), CSF log10 (phosphorylated tau 181), CSF log10 (phosphorylated tau 217), and MRI-based hippocampal volume. Data were included from 190 people carrying PSEN1 pathogenic variants, among whom median age was 39·0 years (IQR 32·0 to 48·0) and AAO was 44·5 years (40·6 to 51·4). 109 (57%) of 190 carriers were female and 81 (43%) were male. Lower GSC values (ie, lower γ-secretase activity than wild-type PSEN1) were associated with earlier AAO (r=0·58; p<0·0001). GSC was associated with MMSE (β=0·08, SE 0·03; p=0·0043), CDR-SB (-0·05, 0·02; p=0·0027), and WMS-R Logical Memory Delayed Recall scores (0·09, 0·02; p=0·0006). Lower GSC values were associated with faster increase in PiB-PET signal (p=0·0054), more rapid decreases in hippocampal volume (4·19, 0·77; p<0·0001), MMSE (0·02, 0·01; p=0·0020), and WMS-R Logical Memory Delayed Recall (0·004, 0·001; p=0·0003). Our findings suggest that clinical heterogeneity in people with autosomal dominant Alzheimer's disease can be at least partly explained by different effects of PSEN1 variants on γ-secretase activity and amyloid β production. They support targeting γ-secretase as a therapeutic approach and suggest that cell-based models could be used to improve prediction of symptom onset. US National Institute on Aging, Alzheimer's Association, German Center for Neurodegenerative Diseases, Raul Carrea Institute for Neurological Research, Japan Agency for Medical Research and Development, Korea Health Industry Development Institute, South Korean Ministry of Health and Welfare, South Korean Ministry of Science and ICT, and Spanish Institute of Health Carlos III.

Crisis of Human Rights of Refugees and Asylum Seekers in Japan

The year 2022 marks the 40th anniversary of the start of Japan’s refugee recognition system. Despite being a prosperous democracy and a staunch supporter of the international system, Japan has consistently admitted only a small number of refugees. According to the Immigration Services Agency of Japan, the number of people recognised as refugees in 2022 reached a record high of 202, while those not recognised exceeded 10,000. Furthermore, the legislative bill to revise the Immigration Control Law, passed by the House of Councillors Judicial Committee on June 8, 2023, limits applications for refugee recognition to twice in principle. From the third application onwards, there is a possibility for forced deportation to the applicants’ home countries. This legislative bill can be seen as violating the human rights of refugees and asylum-seekers, contravening international human rights law, and the 1951 Convention Relating to the Status of Refugees. Therefore, this article specifically explores Japan’s stronger stance on control over protection, whether its low recognition rate indicates non-compliance with international refugee protection criteria, and the reasons behind this. These aspects will be methodically examined, employing rationalist, normative, and domestic institutional theories of international conformity. Finally, the article will suggest measures to improve Japan’s refugee recognition rate and enhance the protection of the human rights of refugees and asylum seekers.

Doublet chemotherapy, triplet chemotherapy, or doublet chemotherapy combined with radiotherapy as neoadjuvant treatment for locally advanced oesophageal cancer (JCOG1109 NExT): a randomised, controlled, open-label, phase 3 trial

Neoadjuvant therapy is the standard treatment for patients with locally advanced oesophageal squamous cell carcinoma (OSCC). However, the prognosis remains poor and more intensive neoadjuvant treatment might be needed to improve patient outcomes. We therefore aimed to compare the efficacy and safety of neoadjuvant doublet chemotherapy, triplet chemotherapy, and doublet chemotherapy plus radiotherapy in patients with previously untreated locally advanced OSCC. In this randomised, open-label, phase 3 trial, patients aged 20-75 years with previously untreated locally advanced OSCC and an Eastern Cooperative Oncology Group performance status of 0 or 1 were recruited from 44 centres across Japan. Patients were randomly assigned (1:1:1) centrally via a web-based system to receive neoadjuvant doublet chemotherapy (two courses of fluorouracil [800 mg/m2 per day intravenously on days 1-5] and cisplatin [80 mg/m2 per day on day 1] separated by an interval of 3 weeks [NeoCF]), triplet chemotherapy (three courses of fluorouracil [750 mg/m2 per day on days 1-5], cisplatin [70 mg/m2 per day on day 1], and docetaxel [70 mg/m2 per day on day 1] repeated every 3 weeks [NeoCF+D]), or doublet chemotherapy (two courses of fluorouracil [1000 mg/m2 per day on days 1-4] and cisplatin [75 mg/m2 per day on day 1] separated by an interval of 4 weeks) plus 41·4 Gy radiotherapy [NeoCF+RT]) followed by oesophagectomy with regional lymph node dissection. Randomisation was stratified by T stage and institution. Participants, investigators, and those assessing outcomes were not masked to group assignment. The primary endpoint was overall survival, analysed by intention to treat. Analysis of safety included all patients who received at least one course of chemotherapy, and analysis of surgical complications included those who also underwent surgery. This study is registered with the Japan Registry of Clinical Trials, jRCTs031180202, and the trial is complete. A total of 601 patients (529 male individuals and 72 female individuals) were randomly assigned between Dec 5, 2012, and July 20, 2018, with 199 patients in the NeoCF group, 202 patients in the NeoCF+D group, and 200 patients in the NeoCF+RT group. Compared with the NeoCF group, during a median follow-up period of 50·7 months (IQR 23·8-70·7), the 3-year overall survival rate was significantly higher in the NeoCF+D group (72·1% [95% CI 65·4-77·8] vs 62·6% [55·5-68·9]; hazard ratio [HR] 0·68, 95% CI 0·50-0·92; p=0·006) but not in the NeoCF+RT group (68·3% [61·3-74·3]; HR 0·84, 0·63-1·12; p=0·12). Grade 3 or higher febrile neutropenia occurred in two (1%) of 193 patients in the NeoCF group, 32 (16%) of 196 patients in the NeoCF+D group, and nine (5%) of 191 patients in the NeoCF+RT group. Treatment-related adverse events leading to termination of neoadjuvant therapy were more common in the NeoCF+D group (18 [9%] of 202 participants) than in the NeoCF+RT group (12 [6%] of 200) and NeoCF group (eight [4%] of 199). There were three (2%) treatment-related deaths during neoadjuvant therapy in the NeoCF group, four (2%) deaths in the NeoCF+D group, and two (1%) deaths in the NeoCF+RT group. Grade 2 or higher postoperative pneumonia, anastomotic leak, and recurrent laryngeal nerve paralysis were reported in 19 (10%), 19 (10%), and 28 (15%) of 185 patients, respectively, in the NeoCF group; 18 (10%), 16 (9%), and 19 (10%) of 183 patients, respectively, in the NeoCF+D group; and 23 (13%), 23 (13%), and 17 (10%) of 178 patients, respectively, in the NeoCF+RT group. The in-hospital deaths following surgery included three deaths in the NeoCF group, two deaths in the NeoCF+D group, and one in the NeoCF+RT group. Neoadjuvant triplet chemotherapy followed by oesophagectomy resulted in a statistically significant overall survival benefit compared with doublet chemotherapy and might be the new standard of care for locally advanced OSCC who are in good condition in Japan. Neoadjuvant doublet chemotherapy plus radiotherapy did not show significant improvement of survival compared with doublet chemotherapy. Japan Agency for Medical Research and Development and National Cancer Center Research and Development Fund.

High Transferability of Neutralizing Antibodies against SARS-CoV-2 to Umbilical Cord Blood in Pregnant Women Vaccinated with BNT162b2 XBB.1.5: A Retrospective Cohort Study.

Coronavirus disease 2019 (COVID-19) can lead to severe respiratory illness, rapid disease progression, and higher rates of intensive care unit admission in pregnant women. Infection during pregnancy is associated with an increased risk of preterm delivery, cesarean section, fetal dysfunction, preeclampsia, and perinatal death. Vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from pregnant women to their fetuses has also been observed. Although severe infections in neonates and infants are rare, newborns can experience serious consequences from COVID-19 due to their suboptimal humoral immune system protection. The amino acids in the structural proteins of SARS-CoV-2 are constantly mutating. Since around January 2023, COVID-19, caused by omicron-type SARS-CoV-2 variants, has been prevalent globally. These variants can evade the immune response triggered by traditional mRNA-based COVID-19 vaccines, such as BNT162b2. Therefore, vaccination with BNT162b2 XBB.1.5, which provides protection against omicron-type SARS-CoV-2 variants, is recommended. This retrospective cohort study included 148 pregnant women who received the BNT162b2 XBB.1.5 vaccine at 30 partner medical institutions from September 2023 to January 2024. We examined the titers of anti-spike glycoprotein SARS-CoV-2 immunoglobin G (IgG) and IgA in the blood and umbilical cord blood obtained from the participants using ELISA. Anti-spike glycoprotein SARS-CoV-2 IgG and IgA titers were highest in the blood and cord blood at late gestational age (28-34 weeks). No serious side effects or adverse events were observed in either the pregnant women or their newborns. Pregnant women who received the BNT162b2 XBB.1.5 vaccine during gestational weeks 28 to 34 had the highest titers of anti-omicron SARS-CoV-2 variant antibodies in their blood. Moreover, these antibodies were transferred to their umbilical cord blood. To validate our findings, large cohort clinical studies involving numerous pregnant women are warranted. This study was funded by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS) and Grants-in-Aid for Medical Research from the Japan Agency for Medical Research and Development (AMED).

List prices and clinical value of anticancer drugs in China, Japan, and South Korea: a retrospective comparative study

High prices of anticancer drugs have raised concerns due to their financial impact on patients and healthcare systems. This study aimed to assess the initial and latest list prices and clinical value of reimbursed anticancer drugs in China, Japan, and South Korea. We identified anticancer drugs newly approved by the National Medical Products Administration of China from January 2012 to June 2022, and by the Pharmaceuticals and Medical Devices Agency of Japan and the Ministry of Food and Drug Safety of South Korea up until June 2022. We compared initial and latest treatment prices between countries and assessed clinical value using patients' survival, quality of life (QoL), and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). We calculated Spearman rank correlation coefficients of treatment prices with clinical value for individual countries and employed regression analyses to investigate whether the relationship between prices and clinical value was modified by the country setting. Our cohort included 91 anticancer drug indications, with 60 listed for reimbursement in China, 91 in Japan, and 87 in South Korea. Median treatment prices were highest in Japan, followed by South Korea, and lowest in China, both for initial prices (US$64082 vs. US$45529 vs. US$19144, p<0.0001) and latest prices (US$50859 vs. US$31611 vs. US$18666, p<0.0001). Over time, China (β=-0.047, p<0.0001) and South Korea (β=-0.049, p<0.0001) witnessed more significant price reductions compared to Japan (β=-0.013, p=0.011). The correlations between both initial and latest treatment prices and clinical value (QoL and ESMO-MCBS) were more significant and stronger in China and South Korea than in Japan, although Japan exhibited slightly stronger correlations in terms of survival compared to China and South Korea. The relationship between clinical value and treatment prices may not be modified by the country setting. In comparison, South Korea's list prices and their correlations with clinical value appear reasonable. Policymakers in Japan could enhance efficiency by controlling prices and aligning them with clinical value, while China would need to take substantial steps to expand anticancer drug coverage. National Natural Science Foundation of China (72374149 and 72074163), and China Center for South Asian Studies, Sichuan University.

Edge AI Model Deployed for Real-Time Detection of Atrial Fibrillation Risk during Sinus Rhythm.

Objectives: The study aimed to develop a deep learning-based edge AI model deployed on electrocardiograph (ECG) devices for the real-time detection of atrial fibrillation (AF) risk during sinus rhythm (SR) using standard 10 s, 12-lead electrocardiograms (ECGs). Methods: A novel approach was used to convert standard 12-lead ECGs into binary images for model input, and a lightweight convolutional neural network (CNN)-based model was trained using data collected by the Japan Agency for Medical and Research Development (AMED) between 2019 and 2022. Patients over 40 years old with digital, SR ECGs were retrospectively enrolled and divided into AF and non-AF groups. The data labeling was supervised by cardiologists. The dataset was randomly allocated into training, validation, and internal testing datasets. External testing was conducted on data collected from other hospitals. Results: The best-trained model achieved an AUC of 0.82 and 0.80, sensitivity of 79.5% and 72.3%, specificity of 77.8% and 77.7%, precision of 78.2% and 76.4%, and overall accuracy of 78.6% and 75.0% in the internal and external testing datasets, respectively. The deployed model and app package utilized 2.5 MB and 40 MB of the available ROM and RAM capacity on the edge ECG device, correspondingly. The processing time for AF risk detection was approximately 2 s. Conclusions: The model maintains comparable performance and improves its suitability for deployment on resource-constrained ECG devices, thereby expanding its potential impact to a wide range of healthcare settings. Its successful deployment enables real-time AF risk detection during SR, allowing for timely intervention to prevent AF-related serious consequences like stroke and premature death.

The Main Contents and Value assess-ment of the Unit 731 Archives Pre-served by the National Archives of Japan

In recent years, huge progress has been made in research on Japanese bacteriological warfare. At present, major sources for scholars to make research mainly come from governmental agencies in China, civil societies in Japan as well as archives, libraries, and museums at central and provincial levels. Based on these documentations, scholars have made accordingly research and historical comments concerning Japanese bacteriological warfare, and medical crimes, hence accomplishing a great number of academic works. However, as current historical documents have been exhausted, works of concerned scholars have demonstrated convergent inclination. The excavation of documentation related to Unit 731 preserved in governmental agencies in Japan, such as the National Archives of Japan and the National Institute for Defense Studies has provided new ideas, clues, and directions for literature surveys and statistics and investigations into basic historical facts of research into Japanese bacteriological warfare.